Green side of the sod

Today on the drive in to the hospital for early morning rounds I was feeling a little sorry for myself. Long hours, long days, feeling rather lonely... I got to the hospital before the sun had risen, trudged through the foot of snow, left my layers in the physician lounge and climbed the stairs to my patients.

One of my ladies is now totally ventilator dependent. After weeks of respiratory failure in the ICU she was scheduled for a tracheostomy placement. At that time I was able to stand in for the conversation where Doc discussed her options which boiled down to waiting while her body slowly lost its ability to remove CO2, becoming more and more hypercapnic, and then comatose, or get vent support. The trouble is that once on a vent you may never be able to wean which lands you in a nursing home dependent on staff for everything. This is not the type of life many people want, but death is a terrifying alternative.

Death is inevitable. I am finding more and more that we do not talk about death enough. Families need to discuss death and dying. What do you want? What type of measures should be taken if you were involved in an accident and could not speak your mind? Why is our culture so driven to live forever? So many people want everything done... "do EVERYTHING you can... go to extremes... save them". Sometimes these attempts are futile and leave us and the family in a worse place then before. Some people should not be resuscitated. Now I am not talking about the young person who was in an accident and now is recovering in the ICU. I am talking about the elderly (most of whom have a laundry list of medical problems) who are spending their lives savings in the ICU only to end up in a nursing home in a vegetative state. I heard that 50% of all medical related costs occur in the last 6 months of a person's life. Hundreds of thousands of dollars to live a few more months.

Back to my patient... she is suffering, her CHF has worsened, her skin is so edematous is is literally sluffing off her body.... Every weaning attempt thus far has failed. Today she mouthed for me to wait. I asked her what was wrong.... she mouthed I'm scared.

These things stay with me. I replay it over and over in my mind.
What can we do for her besides increase her anxiety medications and put her body at ease?